CRBSI20012003 CAUTI20042005 2006 VAP VAP CRBSICAUTI X 2006 pilot study 2007 2008 VAP VAP VAP VAP VAP ICN VAP VAP VAP VAP VAP. VAP 2006 VAP 8 2007 2007 42 VAP 2007 2007 VAP 9 2004 NNIS 2007 2008. VAP 2007 41 2007 VAP p8, 6 VAP [172.873.9 vs 276.0168.1, P=0.04, Mann-Whitney U test VAP ICU X ICN ICU ICU 1
9 ICU 13 IPPBPEEPCPAP 2008 7 1 9 30 3 10 17 web p27, ICU 1 2 1 2 1 ICU ICN ICU ICD ICD [A] ICU X [B] ICN X VAP VAP X "ICU VAP" 48 ICU 48. 48. 4 1 web 2
VAP PNU13 p 9 p16 p17 p18 p22 p24 p26 p26 p30 2007 6 7 p34 3
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National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004. Am J Infect Control. 2004;32:470-85. 5
. VAP 42 30 68 VAP 4 45 62 5 6
VAP (4.83)(4.25)2575 (0, 7.74) 2004 NNIS 2007 45 37.8% 26.7% 15.6%2007 30.3% 30.3% 27.3% 2003 NNIS 27.8% 26.9% 18.1% [Gaynes R, et al. Clin Infect Dis 2005;41:848-54] VAP X (1) 42 (2) VAP VAP ICN VAP VAP CRBSICA-UTIVAP 7
6. VAP 8
NNIS PNEU PNU 1 2 3 4 5 6 7 8 48 4 Moraxella catarrhalish. influenzae S. pneumoniae (MRSA)A B RS Pneumocystis jiroveci () BAL bronchoalveolar labage EIA enzyme immunoassay FAMA fluorescent-antibody staining of membrane antigen IFA immunofluorescent antibody LRT lower respiratory tract PCR polymerase chain reaction PMN polymorphonuclear leukocyte RIA radioimmunoassay 9
PNEU PNEU LUNG BRON 10
PNU 2 1,2 / 1 1 38 (4000/ )(12,000/ ) 70 2 3 [PaO 2 /FiO 2 240 ] PNU 2 1,2 / 1 1 38 (4000/ ) (12,000/ ) 70 3 [PaO 2 /FiO 2 240 ] 8 LRT (BAL ) BAL % ( ) (1) PMN (2) (3) Miller & Jones P2 P3 100 25 10 Geckler 5 11
( ) PNU 2 1,2 / 1 1 38 (4000/ ) (12,000/ ) 70 3 [PaO 2 /FiO 2 240 ] 1 10 12 (EIA,FAMA, Shell vial, PCR) ( ) IgG 4 PCR IF IF RIA EIA IFA 4 1128 EIA 12
PNU3 2 1,2 / 1 1 38 70 3 [PaO 2 /FiO 2 240 ] 1 14,15 LRT (BAL ) Pneumocystis jiroveci PNU2 PNU3 1. 1 ( ) () 327 2. 3. x100 25 10 2, 3 4. 24 5. 1 25 37 13
40 1 75 2 1 60 2~12 1 50 1 1 30 6. () 7. ( FiO 2 )( PaO 2 ) 8. 9. 1 NNIS Miller & Jones 2 100 3 100 25 10 Geckler 5 3 10. RS 11. RS 12. 13. ( 500/mm 3 ) CD4 200 HIV 2 ( 40mg [160mg 32mg mg 200mg ]) 14. 48 15. 14
1. 1g 10 4 cfu B-BAL) 10 4 cfu BAL ( B-PBAL ) 10 4 cfu ( B-PSB ) 10 3 cfu ( ) NB-BAL 10 4 cfu NB-PSB 10 3 cfu 2. Miller & Jones M1 M2 P1 1/3 P2 1/32/3 P3 2/3 3. Geckler 100 1 10 25 2 1025 25 3 25 25 4 25 1025 5 25 10 6 10 25 15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
I. Q1. 7 30 31 8 1 A2. 7 30 9 Q2. 13 VAP 13 A2. NNIS adult 13 13 13 Q3.16 16 10 16 A4. 17 15 Q5. A5. Q6. CHDF - A6. 2 VAP Q7. 70 38 VAP A7. A6 48 Q8. 3-1 A8. 100 25 10 p12, 3 3-1 Q9. 3-3 A9. 3-3 Q10. 3-4 A10. 30
Q11. A11. BAL NNIS Miller & Jones Geckler 9 PNU2 PNU1 Q12. Geckler 4-7 A12. NNIS 100 25 10 p12, 3 Geckler 5 48 Geckler 4, 5 5 Geckler 4 Q13. Geckler 6 G6 A13. VAP Geckler 6 1 1 3,4,5 Geckler 5 G6 Q14. A14. 5-9 (EIA Q15. A15. Q 16. A16. Miller & Jones Geckler PNU Q17. 5% Geckler A17. 5%20 1 Geckler Geckler PNU Q18. BAL A18. NNIS (BAL VAP 31
) Q19. A19. ICU p13, 8 VAP VAP 4-1 VAP VAP VAP. Q20. A20. p13, 13 Q21. CT A21. Q22. VAP A22. VAP Q23. VAP ICU A23. VAP VAP Q24. VAP A24. VAP VAP 2 Q25. VAP VAP A25. VAP quality assurance Q26. A26. 32
Q27. VAP CXp(1 ) CXp(2 ) VAP A27. VAP CXp(1) CXp(2) CXp(1), (2) CXp Q28. A28. 33 1 VAP Q29. device A29. 48 VAP 48 Q30. ICU 36 ICU A30. ICU VAP 12 1 ICU Q31. ICU ICU ICU 48 ICU 24 ICU 48 VAP ICU VAP A31. ICU VAP Q32. p15 A32. 1 ICU Q33PNU1 PNU2 A33 PNU23 1 PNU13 2 Q34. A34. 33
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